'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

The cash-grab survey that asked the wrong questions

If the Department of Health thought the griping over the patient survey would subside once the full results were out, it looks like it was wrong.

Perhaps that's not so surprising, given that the vast majority of practices have been affected. What's more, Pulse's investigation highlights another truth that might make uncomfortable reading for ministers who harp on about reducing health inequalities – the practices that have been hardest hit are those in the most deprived areas, the very GPs who are often struggling to maintain a decent patient service under huge pressure.

It's difficult for ministers to dismiss GPs' grievances as merely self-interested grumbling when Professor Martin Roland, the GP academic who helped develop the survey – and advised Ipsos MORI – has chosen this week to criticise the DH for focusing the questions too heavily on access and ignoring continuity of care.

Now the dust has settled, it's clear the cost to general practice of this survey has been dear – £35m across the UK. More than 3,000 practices are waiting to hear if their appeals against losses of up to £25,000 have been successful. But the omens aren't good. As Pulse went to press, just one PCT had paid out on appeal. And that was for just £750.

The statistical validity of the survey results has been questioned by GP leaders, who point out that in many cases a given practice's results have come from just a handful of patients.

But our investigation suggests it's not as simple as a statistical blunder. In fact, a much bigger chunk of the lost income is down to the tougher thresholds agreed during a brutal round of Government negotiations with the GPC.

It's yet another case of ministers railroading the GPC into accepting changes intended to claw back money the Government believes it has ‘overpaid' GPs since the advent of the 2004 contract.

But what about the impact on patients? Ministers seem hellbent on refusing to accept continuity of care as a quality worth preserving. So they are unlikely to be concerned by research reported by Pulse this week highlighting how general practice is becoming ever more a conveyor belt. Practices whose income is increasingly dependent on providing appointment slots whenever patients want them have found it more and more difficult to maintain the relationships between GPs and patients that are so central to the core values of traditional general practice.

Meanwhile, regardless of whether the survey statistics stand up to scrutiny, our investigation shows the losses are hitting those GP practices that can least afford it.

The central obsession with improving GP access is clearly not going to go away any time soon. But the patient survey as it stands is just a blunt, indiscriminate, money-saving weapon that is taking the biggest share of resources away from the most needy areas. Surely that can't have been what ministers intended?